Notice of Privacy Practices
At Dutch Fork Psychological Services, LLC, we place the highest importance on respecting
and protecting the privacy of our clients and families. We want you to feel comfortable
and confident when you work with us. Therefore, we would like to share with you the
following principles that govern our information sharing and other privacy aspects of
our practice. Throughout this policy, we refer to information that personally identifies
you as Protected Health Information (PHI).
We protect your information.
Dutch Fork Psychological Services is in compliance with all applicable provisions set
forth by the Health Insurance Portability and Accountability Act (HIPAA). The HIPAA law is
a multi-step approach that is geared to improve the health insurance system. We
comply with regulations designed to protect your privacy, including facilitating the
secure exchange of your private health information with insurance companies with your prior
authorization. At the end of this statement you will find additional HIPAA regulations.
We tell you how we use your information.
Dutch Fork Psychological Services protects your PHI from loss, misuse or unauthorized
access by using industry-recognized security safeguards. Paper files
are kept in locked cabinets accessible only to us and our staff. For our
computer files we use technology-based systems including encryption, and we follow
guidelines and The Code of Ethics set forth by the American Psychological Association.
All information you provide as part of the initial registration process, diagnostic
interviews and testing, and/or ongoing treatment is used solely for the purpose of
setting up the client record and for providing requested services. We maintain both
paper and digital client records. Records are used for maintaining information about
the client and family (e.g., contact information), to keep assessment and service data, record time
and charges for billing, and to provide data which may be used for treatment planning,
progress notes, and formal written reports.
Dutch Fork Psychological Services does not sell or rent your personal information to
anyone. We do not share your personal information with anyone outside of our practice
unless you have acknowledged and consented for us to do so (e.g., you may ask us to submit
claims to an insurance company or to send a report to a school or medical doctor),
or unless the law requires us to do so. Unless
indicated otherwise, the information you provide will be viewed only by us and our staff.
Our associates are supervised and trained by Dr. Haxton and/or Dr. Nowell-Haxton,
have signed confidentiality statements on file, and have been educated with regard to
confidentiality and privacy issues.
We tell you about our relationships with third parties.
Dutch Fork Psychological Services maintains limited relationships with third parties to
assist us in serving you. We utilize dictation services, an answering service,
and other temporary contractual service providers. All of these providers
are contractually required to maintain the confidentiality of the
information we provide them. We also may disclose your information if we are required to by
a law enforcement action such as a court order, subpoena or search warrant.
Additional HIPAA Regulations
It is our legal duty to safeguard your Protected Health Information.
By law we are required to insure that your PHI is kept private. The PHI constitutes
information created or noted by us that can be used to identify you. It contains data
about your past, present, or future health condition, the provision of health care
services to you, or the payment for such health care. We are required to provide you with
the Notice about our privacy procedures. This Notice must explain when, why, and how we
would use and/or disclose your PHI. Use of PHI means when we share, apply, utilize,
examine, or analyze information within our practice; PHI is disclosed when we release,
transfer, give or otherwise reveal it to a third party outside our practice. With some
exceptions, we may not use or disclose more of your PHI than is necessary to accomplish
the purpose for which the use or disclosure is made; however, we are always legally
required to follow the privacy practices described in this Notice.
Please note that we reserve the right to change the terms of this Notice and our privacy
policies at any time. Any changes will apply to PHI already on file with us. Before we
make any important changes to our policies, we will immediately change this Notice and
post a new copy of it in our office and on our Web site (if applicable). You may also
request a copy of this Notice from us, or you can view a copy of it in our office.
We will use and disclose your PHI for many different reasons. Some of the uses or
disclosures will require your prior written authorization; others, however, will not.
Below you will find the different categories of our uses and disclosures, with some examples.
Uses and disclosures related to treatment, payment, or health care operations do not
require your prior written consent. We may use and disclose your PHI without your consent
for the following reasons:
- For treatment. We may disclose your PHI to physicians, psychiatrists, psychologists, and
other licensed health care providers who provide you with health care services or are
otherwise involved in your care. Example: If a psychiatrist is treating you, we may disclose
your PHI to her/him in order to coordinate your care.
- We may disclose your PHI to facilitate the efficient and correct operation of our
practice. Examples: We may provide your PHI to our attorney, accountant,
consultants, and others to make sure that we are in compliance with applicable laws.
- When disclosure is required by federal, state, or local law; judicial, board, or
administrative proceedings; or, law enforcement. Example: We may make a disclosure to the
appropriate officials when a law requires us to report information to government agencies,
law enforcement personnel and/or in an administrative proceeding.
- If disclosure is compelled by a party to proceeding before court of an administrative
agency pursuant to its lawful authority. If disclosure is required by a search warrant
lawfully issued to a governmental law enforcement agency. If disclosure is compelled by the
patient or the patient’s representative pursuant to South Carolina Health and Safety codes or
to corresponding federal statutes of regulations, such as the Privacy Rule that requires
- To avoid harm. We may provide PHI to law enforcement personnel or persons able to prevent
or mitigate a serious threat to the health or safety of a person or the public.
- If disclosure is compelled or permitted by the fact that you are in such mental or
emotional condition as to be dangerous to yourself or the person or property of others, or
if we determine that disclosure is necessary to prevent the threatened danger.
- If disclosure is mandated by the South Carolina Child Abuse and Neglect Reporting law.
For example, if we have a reasonable suspicion of child or elder abuse.
- If disclosure is compelled or permitted by the fact that you tell us a serious/imminent
threat of physical violence by you against a reasonably identifiable victim or victims.
- For public health activities. Example: In event of your death, if a disclosure is
permitted or compelled, we may need to give the county coroner information about you.
- For health oversight activities. Example: We may be required to provide information to
assist the government in the course of an investigation or inspection of a health care
organization or provider.
- For specific government functions. Example: We may disclose PHI of military personnel and
veterans under certain circumstances. Also, we may disclose PHI in the interests of
national security, such as protecting the President of the United States or assisting
with intelligence operations.
- For research purposes. In certain circumstances, we may provide PHI in order to conduct
- For Workers Compensation purposes. We may provide PHI in order to comply with Worker’s
- Appointment reminders and health related benefits or services. Example: We may use PHI to
provide appointment reminders. We may use PHI to give you information about alternative
treatment options, or other health care services or benefits we offer.
- If an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully
requested by either party, pursuant to subpoena duces tecum (e.g., a subpoena for
mental health records) or any other provision authorizing disclosure in a proceeding
before an arbitrator or arbitration panel.
- We are permitted to contact you, without your prior authorization, to provide appointment
reminders or information about alternative or other health-related benefits and services
that may be of interest to you.
- If disclosure is required or permitted to a health oversight agency for oversight activities
authorized by law. Example: When compelled by U.S. Secretary of Health and Human Services
to investigate or assess my compliance with HIPAA regulations.
- If disclosure is otherwise specifically required by law. Please note, if you are involved
in a forensic case with either Dr. Haxton or Dr. Nowell-Haxton (such as a case involving
custody determination), the laws which apply to those proceedings and orders of the
court may supersede the privacy extended under HIPAA.
Certain uses and disclosures require you to have the opportunity to object.
Disclosures to family, friends, or others. We may provide your PHI to a family member,
friend, or other individual who you indicate is involved in your care or responsible for
the payment for your health care, unless you object in whole or in part. Retroactive
consent may be obtained in emergency situations.
Other uses and disclosures require your prior written authorization. In any other
situation not described above, we will request your written authorization before using
or disclosing any of your PHI. Even if you have signed an authorization to disclose your
PHI, you may later evoke that authorization, in writing, to stop any future uses and
disclosures (assuming that we haven’t taken any action subsequent to the original
authorization) of your PHI by us.
These are your rights with respect to your PHI:
- The right to see and get copies of your PHI. In general, you have the right to see your
PHI that is in our possession, or to get copies of it; however, you must request it in
writing. If we do not have your PHI, but we know who does, we will advise you how you can
get it. You will receive a response from us within 30 days of our receiving your written
request. Under certain circumstances, we may feel we must deny your request, but if we do,
we will give you, in writing, the reasons for the denial. We will also explain your right
to have our denial reviewed. If you ask for copies of your PHI, we will charge you not
more than $.25 per page. We may see fit to provide you with a summary or explanation of
the PHI, but only if you agree to it, as well as to cost, advance.
- The right to request limits on uses and disclosures of your PHI. You have the right to
ask that we limit how we use and disclose your PHI. While we will consider your request, we are
not legally bound to agree. If we do agree to your request, we will put those limits in writing
and abide by them except in emergency situations. You do not have the right to limit the
uses and disclosures that we are legally required or permitted to make.
- The right to choose how we send your PHI to you. It is your right to ask that your PHI be
sent to you at an alternate address (for example, sending information to your work address
rather than your home address) or by an alternate method (for example, via email instead
of by regular mail). We are obliged to agree to your request providing that we can give you
the PHI in the format you requested without undue inconvenience.
- The right to get a list of the disclosures we have made. You are entitled to a list of
disclosures of your PHI that we have made. The list will not include uses or disclosures
to which you have already consented, i.e., those for treatment, payment, or health care
operations, sent directly to you or to your family; neither will the list include
disclosures made for national security purposes, to corrections or law enforcement
personnel, or disclosures made before April 15, 2003. After April 15, 2003, disclosure
records will be held for six years.
We will respond to your request for an accounting of disclosures within 60 days of
receiving your request. The list we give you will include disclosures made in
the previous six years unless you indicate a shorter period. The list will
include the date of the disclosure, to whom PHI was disclosed
(including their address, if known), description of the information disclosed, and the
reason for the disclosure. We will provide the list to you at no cost, unless you make
more than one request in the same year, in which case we will charge you a reasonable
sum based on a set fee for each additional request.
- The right to amend your PHI. If you believe that there is some error in your PHI or that
important information has been omitted, it is your right to request that we correct the
existing information or add the missing information. Your request and the reason for the
request must be made in writing. You will receive a response within 60 days of our receipt
of your request. We may deny your request, in writing, if we find that: the PHI is (a) correct
and complete, (b) forbidden to be disclosed, (c) not part of our records, or (d) written by
someone other than us. Our denial must be in writing and must state the reasons
for the denial.
It must also explain your right to file a written statement objecting to the denial. If you
do not file a written objection, you still have the right to ask that your request and our
denial be attached to any future disclosures of your PHI. If we approve your request, we will
make the change(s) to your PHI. Additionally, we will tell you that the changes have been
made, and we will advise all others who need to know about the change(s) to your PHI.
- The right to get this notice by email. You have the right to get this notice by email,
as well as request a paper copy of it.
HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If, in your opinion, we may have violated your privacy rights, or if you object to a
decision we made about access to your PHI, you are entitled to discuss this directly
with us. You may also send a written complaint to the Secretary of the Department of
Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201. If
you file a complaint about our privacy practice, we will take no retaliatory action against you.
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